Plasma Expanders

PLASMA EXPANDERS
 Loss of plasma occurs in cases of burns, severe

trauma that causes tissue damage, endotoxic
shock and haemorrhage.
 It is important to note that loss of plasma also
leads to hypovolemic shock.
 In case of non-availability of plasma or blood
other agents are used.
 Fluids that can be administered are human
plasma, plasma substitutes, saline and Ringer’s
lactate.
PLASMA EXPANDERS
Plasma expanders are substances that increase the
circulatory volume.
They may be colloid or crystalloid.
Colloidal plasma expanders are dextran, degraded
gelatin polymer, human albumin solution, PVP and
hydroxyethyl starch
Crystalloid plasma expander is isotonic or normal
saline solution.
PROPERTIES OF AN IDEAL PLASMA
EXPANDER
Ideal plasma expander means its properties should be similar to
plasma as follows.
• Similar oncotic pressure and similar viscosity.
• Duration of action should fulfill the requirement i.e. long acting and
then it should be eliminated with or without metabolism.
• No antigenicity or pyrogenic action
• Should be devoid of any pharmacological effect i.e. inert.
• Should be economical and easily available.
• Can be stored for longer period up to years together i.e. it should
withstand environmental fluctuation.
PLASMA EXPANDERS
• Colloidal plasma expanders
• High molecular weight
• Longer period
• Maintain the oncotic pressure.
• The crystalloid plasma expanders

• Act immediately
• Short lasting.
PLASMA EXPANDERS
Colloidal plasma expanders
• Dextran and degraded gelatin polymer are most commonly
used.
• Both of them have some common advantages
• Both are readily available
• No need of reconstitution
• Safe, no risk of disease such as serum hepatitis
• Easy to use.
• Economical
DEXTRAN
Low mol. Weight called dextran 40 and high mol. Wt.
called dextran 70.
Dextrans oncotic pressure is equivalent to plasma
Effect persists for about 24 h.
• Volume expansion
• Improve microcirculation
• Prevents aggregation of RBCs
• Reduce viscosity of blood.
• Stored for very long period up to 10 years.
DISADVANTAGES OF DEXTRANS:
• Interfere with technique of blood
grouping and cross matching.
• Bleeding time can be prolonged as it
interferes with coagulation
• Interferes with platelet function so
haemorrhage may occur in overdose.
• Increase specific gravity of urine and so
interfere the assessment of renal function.
CONTRAINDICATIONS
• Antigenic reaction may occur and thus can
not be used in patients allergic to dextran.
• Avoided in patients with heart failure
• Patients of renal dysfunction
• Patients with bleeding disorder due to
reduced fibrinogen or platelets
USES:
1. To increase blood volume in cases of loss of

plasma or blood.
2. To decrease blood sludging and improve blood
flow
3. Used for prevention of postsurgical thrombosis
as they inhibit platelet function
4. Dextran 40 can also be used for stroke and
pulmonary infarction
5. Used as viscosity increasing agent in dry eye.
• Dextran 70 has slow action retained in body in liver & RES.
• Dextran 40 has rapid action and rapidly eliminated in kidney.
• Dextran 40 may cause acute oliguric renal failure as it may
block the renal tubules
• To prevent it
1. It should not be used if urine formation is less than 1500 or if
blood urea is more than 60 mg %
2. If specific gravity of urine rises more than 1.045
3. The daily dose should not exceed 10 ml/kg, The duration of
use should not exceed 5 days.
DEGRADED GELATIN POLYMER
(POLYGELINE)
• Polymer derived from degraded gelatin contains
electrolyte in proportion close to human plasma but
calcium ion is in high concentration
• Stable for about 3 years.
• Its major portion is excreted unchanged, slowly
through kidneys.
ADVANTAGES:
• Its is about 4-5 h so less chances of overloading.

• Provides colloid and crystalloid both i.e. a balanced
solution and thus can be considered as near ideal
substitute.
• No interference with blood grouping and matching.
• Antigenicity is negligible, however, allergic reaction
such as flushing , urticaria, bronchospasm and
hypotension may occur occasionally
• It can also be used as vehicle for drugs such as
antibiotics, vitamins etc as per the requirement.
Disadvantages:
• Costly as compared to dextran
HUMAN ALBUMIN
• Derived from human whole blood and also from pooled

human plasma.
ADVANTAGES:
• Does not interfere with coagulation.
• No blood group matching is required.
• No risk of blood transfusion transmitted disease notably
HIV and hepatitis B.
• Sensitization dose not occur on repeated infusions.
DISADVANTAGES:
• Fever may occur
• High cost
USES:
1. Hypovolaemia due to loss of fluid due to any reason
e.g. diarrheoa, vomiting and burns
2. Acute hypoproteinaemia
3. Hepatic and renal failure to replenish the proteins
apart from other measures.
• If there is oedema then undiluted solution is
recommended.
POLYVINYLPYRROLIDONE(PVP)
• It is synthetic water soluble heterogeneous polymer
• The fraction with large molecular weight is stored for
many years in RE system, skin and skeletal muscles for
longer period.
• It is excreted in urine and small portion in bile slowly.
• It is used as 3.5 % solution intravenously in buffered
normal saline
DISADVANTAGES:
• Interferes with technique of blood grouping and
cross matching as it causes agglutination of red
blood cells.
• Causes histamine release.
• Fraction with large molecular size stored may
interfere with antibody formation.
INTERACTION:
• Binds with penicillin and insulin so cannot be used
with these drugs.
HYDROXYETHYLSTARCH
• Starch is destroyed by amylase but hydroxyethyl derivatives
are resistant to enzyme amylase.
• Hydroxyethylstarch is a complex mixture and formed by
ethoxylation of amylopectin.
• Its advantages over dextran are that its duration is longer,
does not cause allergic reaction and does not interfere with
coagulation and no chances of renal failure.
• 6 % solution is used
• It adverse effects are vomiting, fever, itching and
anaphylactoid reaction manifested as urticaria,
bronchospasm etc.
• It accelerates sedimentation of red blood cells and thus,
additionally may used for isolation of granulocytes.
Important questions
 Name few plasma expanders
 List few contraindications for plasma

expanders
 What are the uses of plasma expanders
 What are the ideal properties of a plasma

expander
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PLASMA EXPANDERS

 Loss of plasma occurs in cases of burns, severe

• The crystalloid plasma expanders

1. To increase blood volume in cases of loss of

• Its is about 4-5 h so less chances of overloading.

• Derived from human whole blood and also from pooled

 List few contraindications for plasma

 What are the uses of plasma expanders

 What are the ideal properties of a plasma

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